Influenza and influenza related illnesses are the eighth leading cause of death in the United States. Although the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention (CDC) recommend influenza vaccination for all individuals 50 and older, vaccination rates among those 50 - 64 only reach approximately 36.0 percent and rates among those 65 and older only reach 64 percent. Interventions to increase vaccination rates include printed educational materials, such as the CDC's "Flu Vaccine Facts &Myths." Recent research questions the efficacy of this approach, suggesting that individuals, especially as they age, often misremember myths as facts due to an "illusion of truth" effect. Such research suggests use of a "Facts only" message may be more prudent. However, communication "message sidedness research" demonstrates that a two-sided refutational message;containing original arguments (facts), counterarguments (myths), and a refutation of the counterarguments is more persuasive than a one-sided (facts only) message. This study seeks to elucidate the effect of theory-driven alternatives to standard "facts and myths" presentation in a controlled trial. The specific aims are: Aim 1: Design three alternative messages related to influenza and influenza vaccination: (1) a one-sided message ("facts only");(2) a two-sided non-refutational message ("facts and myths");and (3) a two- sided refutational message ("facts, myths, and refutations"). Aim 2: Conduct a four-arm Randomized Trial to compare the three alternative messages developed in Aim 1 with each other as well as with the existing CDC "Flu Vaccine Facts &Myths" flyer as measured by knowledge, attitudes, recall, intention, and influenza vaccination among individuals 50 and older. Aim 2a: Examine whether or not there are differences in responses to the four messages based on participant health literacy. Aim 2b: Examine whether or not there are differences in responses to the four messages based on participant age. Aim 1 will be achieved by a process of message design informed by cognitive interviews and an advisory board. Aim 2 will be accomplished through a randomized trial: Participants 50 years of age and older who indicate they have neither received the influenza vaccine nor intend to receive the vaccine will be randomly assigned to study groups (i.e., message type), complete a pre-test telephone interview, receive one of the four printed message flyers one week prior to a previously scheduled physician visit, and complete a post-test interview. Pre- and post-test interview protocols will assess: knowledge and attitudes regarding the flu/flu shot and intention to be vaccinated;the post test will include items assessing message recall and health literacy. Vaccination will be assessed by querying the Electronic Health Record (EHR) following the clinic visit. PUBLIC HEALTH RELEVANCE: Many public health messages use a "Facts &Myths" format to refute false information. However, researchers disagree as to the wisdom of this approach: some are concerned that individuals, particularly as they age, misremember myths as facts;others suggest that a well-crafted message that includes a refutation of any myths presented can be effective. The proposed research will test these competing claims on individuals 50 and older through a randomized trial using messages about influenza and influenza vaccination.